NSG 6020 Final Exam: Comprehensive Primary Care and Health Assessment Advanced Practice Nursing | 2026/2027
NSG 6020 FINAL EXAM (LATEST, 2026/2027)
3 VERSIONS: 150 QUESTIONS WITH 100% CORRECT ANSWERS
Comprehensive Primary Care, Advanced Health Assessment, and Clinical Decision-Making
Advanced Practice Nursing Education | Nurse Practitioner Program
150 Questions | Evidence-Based Rationales | Aligned with 2026-2027 Curriculum Standards
VERSION A: Comprehensive Primary Care Exam (Q1-50)
Section A1: Foundations of Primary Care (History Taking, Physical Exam, and Documentation)
Questions 1-10
Q1: A 58-year-old male presents to the primary care clinic complaining of chest discomfort. Using the standard HPI
framework recommended by the National Board of Medical Examiners, which of the following represents the correct
eight components of the History of Present Illness (HPI)?
A. Location, quality, severity, duration, timing, context, modifying factors, and associated signs/symptoms
[CORRECT]
B. Onset, location, duration, character, aggravating factors, relieving factors, radiation, and timing
C. Provocation, quality, region, severity, timing, onset, course, and associated symptoms
D. Site, onset, character, radiation, associations, time course, exacerbating factors, and severity
Correct Answer: A
Rationale: The eight components of the HPI are: location, quality, severity, duration, timing, context, modifying factors, and
associated signs/symptoms. While mnemonic variations such as OLDCARTS and OPQRST exist for clinical practice, the NBME
standardized format uses these eight specific elements. A thorough HPI is essential for accurate differential diagnosis and meets
documentation requirements for E/M coding at the detailed or comprehensive level per CMS guidelines.
Q2: A 72-year-old female with hypertension, type 2 diabetes mellitus, and osteoarthritis presents for an annual
wellness visit. She reports seeing her cardiologist and endocrinologist within the past month. Which component of the
comprehensive health history is most critical for the nurse practitioner to perform at this visit to prevent adverse drug
events?
A. Complete medication reconciliation including all prescriptions, OTC medications, herbals, and supplements
[CORRECT]
B. Focused review of systems specific to her chronic disease conditions
C. Detailed family history focusing on cardiovascular and endocrine disorders
D. Comprehensive social history including tobacco, alcohol, and illicit substance use
Correct Answer: A
Rationale: Medication reconciliation is the most critical component when a patient sees multiple prescribers, as it identifies potential
drug-drug interactions, duplications, and omissions. Studies show that up to 50% of older adults take five or more medications,
increasing the risk of adverse drug events. The Joint Commission identifies medication reconciliation as a National Patient Safety
Goal, and the USPSTF recommends periodic review of all medications in older adults as part of comprehensive care.
Page 1
,Q3: A nurse practitioner is performing a comprehensive physical examination on a new patient. According to the
IPPA (Inspection, Palpation, Percussion, Auscultation) framework, which technique should always be performed first
during examination of any body system?
A. Inspection, as it provides initial visual clues about the patient's condition before hands-on examination
[CORRECT]
B. Palpation, to establish the patient's baseline comfort level with physical touch
C. Percussion, because it provides objective data about underlying structures
D. Auscultation, to capture any transient sounds before they are altered by examination
Correct Answer: A
Rationale: Inspection is always performed first in the IPPA sequence because it yields important visual information without altering
the examination findings. Palpation, percussion, or auscultation performed prematurely can change the appearance of the area being
examined (e.g., causing erythema, altering bowel sounds, or changing the position of organs). The cardinal exception is abdominal
examination, where auscultation precedes percussion and palpation to avoid altering bowel sounds.
Q4: During an abdominal examination on a 45-year-old patient with chronic abdominal pain, the nurse practitioner
deviates from the standard IPPA sequence. Which modification of the examination sequence is correct for abdominal
assessment?
A. Inspect, then auscultate, then percuss, then palpate [CORRECT]
B. Inspect, then palpate, then percuss, then auscultate
C. Auscultate first, then inspect, then palpate, then percuss
D. Percuss first, then auscultate, then inspect, then palpate
Correct Answer: A
Rationale: In abdominal examination, the correct sequence is Inspection, Auscultation, Percussion, Palpation (IAPP). Auscultation is
performed before percussion and palpation because pressing on the abdomen can alter bowel sounds, leading to inaccurate
assessment. This is the only body system where auscultation is performed before percussion and palpation. Palpation is performed last
as it is the most invasive technique and may cause pain or guarding that could affect subsequent examination findings.
Q5: A 34-year-old female presents with a 3-day history of dysuria, urinary frequency, and low-grade fever. The NP
diagnoses an uncomplicated urinary tract infection. In the SOAP note documentation, under which section should the
NP record the negative results of the pelvic examination and the absence of costovertebral angle tenderness?
A. Objective section, as these are findings obtained through physical examination [CORRECT]
B. Subjective section, because the patient reported no back pain
C. Assessment section, as they support the clinical reasoning for the diagnosis
D. Plan section, because they determine the need for further diagnostic testing
Correct Answer: A
Rationale: The Objective section of the SOAP note contains all measurable and observable data obtained during the physical
examination, vital signs, and diagnostic test results. Negative physical examination findings such as the absence of costovertebral
angle tenderness and normal pelvic examination results belong in the Objective section. The Subjective section contains the patient's
reported symptoms, the Assessment section contains the diagnoses, and the Plan section contains treatment recommendations.
Q6: A nurse practitioner is evaluating a 67-year-old male with poorly controlled hypertension (BP 164/98 mmHg),
type 2 diabetes with diabetic retinopathy, and stage 3 chronic kidney disease. When assigning ICD-10-CM codes for
this encounter, which coding principle takes highest priority?
, A. Code the condition that is the primary reason for the encounter first, followed by comorbidities that affect
management [CORRECT]
B. Code all chronic conditions in alphabetical order by diagnosis name
C. Code the most severe condition first regardless of the reason for the visit
D. Code only the condition that requires a new prescription or intervention
Correct Answer: A
Rationale: According to ICD-10-CM Official Coding Guidelines, the first-listed diagnosis should be the condition that is the primary
reason for the current encounter. Comorbidities that affect patient management or require monitoring should also be coded as
secondary diagnoses. In this scenario, if the visit is for hypertension management, that code is listed first, with diabetes with
retinopathy and CKD coded as secondary conditions that influence treatment decisions. Accurate coding is essential for
reimbursement, quality metrics, and clinical documentation integrity.
Q7: A 40-year-old African American female with a BMI of 32 kg/m² presents for a well-woman visit. She has no
personal or family history of breast cancer. Her mother was diagnosed with colon cancer at age 58. According to
current USPSTF 2026 guidelines, which screening recommendation is most appropriate for this patient?
A. Begin colorectal cancer screening now due to her family history, which places her at higher-than-average risk
[CORRECT]
B. Defer colorectal cancer screening until age 45, as she does not meet criteria for early screening
C. Begin mammography screening immediately due to her African American ethnicity and elevated BMI
D. Recommend only lifestyle modifications and defer all cancer screening until age 50
Correct Answer: A
Rationale: The USPSTF recommends initiating colorectal cancer screening at age 45 for average-risk adults (Grade B). However, this
patient has a first-degree relative diagnosed with colon cancer before age 60, which places her at increased risk per USPSTF criteria.
For individuals with a first-degree relative with colorectal cancer diagnosed before age 60, screening should begin at age 40 or 10
years before the relative's diagnosis, whichever comes first. Mammography initiation for average-risk women remains at age 40 per
updated 2024 USPSTF guidelines.
Q8: A 52-year-old male with no significant medical history presents for a routine physical examination. His blood
pressure is 128/82 mmHg, fasting glucose is 108 mg/dL, and lipid panel shows LDL 142 mg/dL, HDL 38 mg/dL, and
triglycerides 198 mg/dL. Which USPSTF screening or preventive recommendation has the strongest evidence (Grade
A) for this patient at this visit?
A. Screening for lipid disorders in adults aged 40-75 years to assess cardiovascular risk [CORRECT]
B. Screening for type 2 diabetes mellitus in asymptomatic adults
C. Screening for abdominal aortic aneurysm with ultrasonography
D. Screening for hepatitis C virus infection in all adults
Correct Answer: A
Rationale: The USPSTF assigns a Grade A recommendation for statin therapy and lipid screening in adults aged 40-75 years with one
or more cardiovascular risk factors (Barker et al., 2022). This patient has multiple risk factors including borderline hypertension,
prediabetes (fasting glucose 100-125 mg/dL), and dyslipidemia. While diabetes screening and hepatitis C screening are recommended
(Grade B), the strongest evidence supports cardiovascular risk assessment and lipid disorder screening in this age group. AAA
screening is Grade B for men aged 65-75 who have ever smoked.
Q9: A 28-year-old Mexican-American female presents with persistent headaches. During the health history, she
mentions using a 'curandero' (traditional healer) and drinking herbal teas for her symptoms. She appears reluctant to
, discuss this further. Which response by the nurse practitioner best demonstrates cultural competence?
A. Acknowledge the use of the curandero respectfully, ask about the specific herbs used, and integrate this
information into the clinical assessment while ensuring patient safety [CORRECT]
B. Advise the patient that traditional remedies are not evidence-based and recommend she discontinue them
immediately
C. Document the use of alternative therapies but focus exclusively on the biomedical evaluation
D. Refer the patient to a cultural liaison before proceeding with any clinical assessment
Correct Answer: A
Rationale: Cultural competence requires the NP to acknowledge and respect the patient's cultural health practices while ensuring
clinical safety. The National Standards for Culturally and Linguistically Appropriate Services (CLAS) emphasize that providers
should ask about complementary and alternative medicine use in a non-judgmental manner. Some herbal remedies may interact with
prescribed medications (e.g., St. John's Wort with SSRIs), so identifying specific herbs is clinically important. Dismissing traditional
practices undermines therapeutic rapport and may lead to non-disclosure and treatment non-adherence.
Q10: A 65-year-old male with newly diagnosed heart failure is being discharged from the primary care clinic. He has
a sixth-grade reading level and appears overwhelmed by his medication regimen (lisinopril, carvedilol, furosemide,
and potassium chloride). Which interprofessional approach is most effective to ensure medication adherence and
health literacy in this patient?
A. Collaborate with a clinical pharmacist for medication reconciliation and use teach-back method with
pictogram-based medication instructions at an appropriate literacy level [CORRECT]
B. Provide the patient with printed drug information sheets from the pharmacy and schedule a follow-up in 2 weeks
C. Refer the patient to a social worker for placement in an assisted living facility
D. Simplify the regimen to two medications and provide verbal instructions at the time of discharge
Correct Answer: A
Rationale: The teach-back method is the gold standard for assessing patient understanding, particularly for patients with limited
health literacy. The AHA and HFSA guidelines emphasize interprofessional collaboration with clinical pharmacists for heart failure
patients on complex regimens. Pictogram-based aids and simplified language (at or below a 5th-grade reading level) improve
comprehension and adherence. Simply providing written materials is insufficient, as they are often written above the average reading
level. Medication simplification without prescriber input may compromise therapeutic efficacy.
Section A2: Cardiovascular and Respiratory Conditions
Questions 11-20
Q11: A 68-year-old male with a history of hypertension and coronary artery disease presents with increasing dyspnea
on exertion and bilateral lower extremity edema. On auscultation, a low-frequency extra sound is heard immediately
after S2 at the cardiac apex with the patient in the left lateral decubitus position. Which heart sound is this, and what is
its clinical significance?
A. S3 gallop, indicating volume overload and suggestive of heart failure with reduced ejection fraction [CORRECT]
B. S4 gallop, indicating a stiff, noncompliant ventricle typically seen in diastolic dysfunction
C. Opening snap, indicative of mitral stenosis with a thickened mitral valve
D. Ejection click, consistent with a bicuspid aortic valve or pulmonic stenosis
Correct Answer: A
Rationale: The S3 (third heart sound or ventricular gallop) is a low-frequency sound heard early in diastole, immediately after S2. It
is caused by rapid ventricular filling into a noncompliant ventricle and is best heard at the cardiac apex with the patient in the left
NSG 6020 FINAL EXAM (LATEST, 2026/2027)
3 VERSIONS: 150 QUESTIONS WITH 100% CORRECT ANSWERS
Comprehensive Primary Care, Advanced Health Assessment, and Clinical Decision-Making
Advanced Practice Nursing Education | Nurse Practitioner Program
150 Questions | Evidence-Based Rationales | Aligned with 2026-2027 Curriculum Standards
VERSION A: Comprehensive Primary Care Exam (Q1-50)
Section A1: Foundations of Primary Care (History Taking, Physical Exam, and Documentation)
Questions 1-10
Q1: A 58-year-old male presents to the primary care clinic complaining of chest discomfort. Using the standard HPI
framework recommended by the National Board of Medical Examiners, which of the following represents the correct
eight components of the History of Present Illness (HPI)?
A. Location, quality, severity, duration, timing, context, modifying factors, and associated signs/symptoms
[CORRECT]
B. Onset, location, duration, character, aggravating factors, relieving factors, radiation, and timing
C. Provocation, quality, region, severity, timing, onset, course, and associated symptoms
D. Site, onset, character, radiation, associations, time course, exacerbating factors, and severity
Correct Answer: A
Rationale: The eight components of the HPI are: location, quality, severity, duration, timing, context, modifying factors, and
associated signs/symptoms. While mnemonic variations such as OLDCARTS and OPQRST exist for clinical practice, the NBME
standardized format uses these eight specific elements. A thorough HPI is essential for accurate differential diagnosis and meets
documentation requirements for E/M coding at the detailed or comprehensive level per CMS guidelines.
Q2: A 72-year-old female with hypertension, type 2 diabetes mellitus, and osteoarthritis presents for an annual
wellness visit. She reports seeing her cardiologist and endocrinologist within the past month. Which component of the
comprehensive health history is most critical for the nurse practitioner to perform at this visit to prevent adverse drug
events?
A. Complete medication reconciliation including all prescriptions, OTC medications, herbals, and supplements
[CORRECT]
B. Focused review of systems specific to her chronic disease conditions
C. Detailed family history focusing on cardiovascular and endocrine disorders
D. Comprehensive social history including tobacco, alcohol, and illicit substance use
Correct Answer: A
Rationale: Medication reconciliation is the most critical component when a patient sees multiple prescribers, as it identifies potential
drug-drug interactions, duplications, and omissions. Studies show that up to 50% of older adults take five or more medications,
increasing the risk of adverse drug events. The Joint Commission identifies medication reconciliation as a National Patient Safety
Goal, and the USPSTF recommends periodic review of all medications in older adults as part of comprehensive care.
Page 1
,Q3: A nurse practitioner is performing a comprehensive physical examination on a new patient. According to the
IPPA (Inspection, Palpation, Percussion, Auscultation) framework, which technique should always be performed first
during examination of any body system?
A. Inspection, as it provides initial visual clues about the patient's condition before hands-on examination
[CORRECT]
B. Palpation, to establish the patient's baseline comfort level with physical touch
C. Percussion, because it provides objective data about underlying structures
D. Auscultation, to capture any transient sounds before they are altered by examination
Correct Answer: A
Rationale: Inspection is always performed first in the IPPA sequence because it yields important visual information without altering
the examination findings. Palpation, percussion, or auscultation performed prematurely can change the appearance of the area being
examined (e.g., causing erythema, altering bowel sounds, or changing the position of organs). The cardinal exception is abdominal
examination, where auscultation precedes percussion and palpation to avoid altering bowel sounds.
Q4: During an abdominal examination on a 45-year-old patient with chronic abdominal pain, the nurse practitioner
deviates from the standard IPPA sequence. Which modification of the examination sequence is correct for abdominal
assessment?
A. Inspect, then auscultate, then percuss, then palpate [CORRECT]
B. Inspect, then palpate, then percuss, then auscultate
C. Auscultate first, then inspect, then palpate, then percuss
D. Percuss first, then auscultate, then inspect, then palpate
Correct Answer: A
Rationale: In abdominal examination, the correct sequence is Inspection, Auscultation, Percussion, Palpation (IAPP). Auscultation is
performed before percussion and palpation because pressing on the abdomen can alter bowel sounds, leading to inaccurate
assessment. This is the only body system where auscultation is performed before percussion and palpation. Palpation is performed last
as it is the most invasive technique and may cause pain or guarding that could affect subsequent examination findings.
Q5: A 34-year-old female presents with a 3-day history of dysuria, urinary frequency, and low-grade fever. The NP
diagnoses an uncomplicated urinary tract infection. In the SOAP note documentation, under which section should the
NP record the negative results of the pelvic examination and the absence of costovertebral angle tenderness?
A. Objective section, as these are findings obtained through physical examination [CORRECT]
B. Subjective section, because the patient reported no back pain
C. Assessment section, as they support the clinical reasoning for the diagnosis
D. Plan section, because they determine the need for further diagnostic testing
Correct Answer: A
Rationale: The Objective section of the SOAP note contains all measurable and observable data obtained during the physical
examination, vital signs, and diagnostic test results. Negative physical examination findings such as the absence of costovertebral
angle tenderness and normal pelvic examination results belong in the Objective section. The Subjective section contains the patient's
reported symptoms, the Assessment section contains the diagnoses, and the Plan section contains treatment recommendations.
Q6: A nurse practitioner is evaluating a 67-year-old male with poorly controlled hypertension (BP 164/98 mmHg),
type 2 diabetes with diabetic retinopathy, and stage 3 chronic kidney disease. When assigning ICD-10-CM codes for
this encounter, which coding principle takes highest priority?
, A. Code the condition that is the primary reason for the encounter first, followed by comorbidities that affect
management [CORRECT]
B. Code all chronic conditions in alphabetical order by diagnosis name
C. Code the most severe condition first regardless of the reason for the visit
D. Code only the condition that requires a new prescription or intervention
Correct Answer: A
Rationale: According to ICD-10-CM Official Coding Guidelines, the first-listed diagnosis should be the condition that is the primary
reason for the current encounter. Comorbidities that affect patient management or require monitoring should also be coded as
secondary diagnoses. In this scenario, if the visit is for hypertension management, that code is listed first, with diabetes with
retinopathy and CKD coded as secondary conditions that influence treatment decisions. Accurate coding is essential for
reimbursement, quality metrics, and clinical documentation integrity.
Q7: A 40-year-old African American female with a BMI of 32 kg/m² presents for a well-woman visit. She has no
personal or family history of breast cancer. Her mother was diagnosed with colon cancer at age 58. According to
current USPSTF 2026 guidelines, which screening recommendation is most appropriate for this patient?
A. Begin colorectal cancer screening now due to her family history, which places her at higher-than-average risk
[CORRECT]
B. Defer colorectal cancer screening until age 45, as she does not meet criteria for early screening
C. Begin mammography screening immediately due to her African American ethnicity and elevated BMI
D. Recommend only lifestyle modifications and defer all cancer screening until age 50
Correct Answer: A
Rationale: The USPSTF recommends initiating colorectal cancer screening at age 45 for average-risk adults (Grade B). However, this
patient has a first-degree relative diagnosed with colon cancer before age 60, which places her at increased risk per USPSTF criteria.
For individuals with a first-degree relative with colorectal cancer diagnosed before age 60, screening should begin at age 40 or 10
years before the relative's diagnosis, whichever comes first. Mammography initiation for average-risk women remains at age 40 per
updated 2024 USPSTF guidelines.
Q8: A 52-year-old male with no significant medical history presents for a routine physical examination. His blood
pressure is 128/82 mmHg, fasting glucose is 108 mg/dL, and lipid panel shows LDL 142 mg/dL, HDL 38 mg/dL, and
triglycerides 198 mg/dL. Which USPSTF screening or preventive recommendation has the strongest evidence (Grade
A) for this patient at this visit?
A. Screening for lipid disorders in adults aged 40-75 years to assess cardiovascular risk [CORRECT]
B. Screening for type 2 diabetes mellitus in asymptomatic adults
C. Screening for abdominal aortic aneurysm with ultrasonography
D. Screening for hepatitis C virus infection in all adults
Correct Answer: A
Rationale: The USPSTF assigns a Grade A recommendation for statin therapy and lipid screening in adults aged 40-75 years with one
or more cardiovascular risk factors (Barker et al., 2022). This patient has multiple risk factors including borderline hypertension,
prediabetes (fasting glucose 100-125 mg/dL), and dyslipidemia. While diabetes screening and hepatitis C screening are recommended
(Grade B), the strongest evidence supports cardiovascular risk assessment and lipid disorder screening in this age group. AAA
screening is Grade B for men aged 65-75 who have ever smoked.
Q9: A 28-year-old Mexican-American female presents with persistent headaches. During the health history, she
mentions using a 'curandero' (traditional healer) and drinking herbal teas for her symptoms. She appears reluctant to
, discuss this further. Which response by the nurse practitioner best demonstrates cultural competence?
A. Acknowledge the use of the curandero respectfully, ask about the specific herbs used, and integrate this
information into the clinical assessment while ensuring patient safety [CORRECT]
B. Advise the patient that traditional remedies are not evidence-based and recommend she discontinue them
immediately
C. Document the use of alternative therapies but focus exclusively on the biomedical evaluation
D. Refer the patient to a cultural liaison before proceeding with any clinical assessment
Correct Answer: A
Rationale: Cultural competence requires the NP to acknowledge and respect the patient's cultural health practices while ensuring
clinical safety. The National Standards for Culturally and Linguistically Appropriate Services (CLAS) emphasize that providers
should ask about complementary and alternative medicine use in a non-judgmental manner. Some herbal remedies may interact with
prescribed medications (e.g., St. John's Wort with SSRIs), so identifying specific herbs is clinically important. Dismissing traditional
practices undermines therapeutic rapport and may lead to non-disclosure and treatment non-adherence.
Q10: A 65-year-old male with newly diagnosed heart failure is being discharged from the primary care clinic. He has
a sixth-grade reading level and appears overwhelmed by his medication regimen (lisinopril, carvedilol, furosemide,
and potassium chloride). Which interprofessional approach is most effective to ensure medication adherence and
health literacy in this patient?
A. Collaborate with a clinical pharmacist for medication reconciliation and use teach-back method with
pictogram-based medication instructions at an appropriate literacy level [CORRECT]
B. Provide the patient with printed drug information sheets from the pharmacy and schedule a follow-up in 2 weeks
C. Refer the patient to a social worker for placement in an assisted living facility
D. Simplify the regimen to two medications and provide verbal instructions at the time of discharge
Correct Answer: A
Rationale: The teach-back method is the gold standard for assessing patient understanding, particularly for patients with limited
health literacy. The AHA and HFSA guidelines emphasize interprofessional collaboration with clinical pharmacists for heart failure
patients on complex regimens. Pictogram-based aids and simplified language (at or below a 5th-grade reading level) improve
comprehension and adherence. Simply providing written materials is insufficient, as they are often written above the average reading
level. Medication simplification without prescriber input may compromise therapeutic efficacy.
Section A2: Cardiovascular and Respiratory Conditions
Questions 11-20
Q11: A 68-year-old male with a history of hypertension and coronary artery disease presents with increasing dyspnea
on exertion and bilateral lower extremity edema. On auscultation, a low-frequency extra sound is heard immediately
after S2 at the cardiac apex with the patient in the left lateral decubitus position. Which heart sound is this, and what is
its clinical significance?
A. S3 gallop, indicating volume overload and suggestive of heart failure with reduced ejection fraction [CORRECT]
B. S4 gallop, indicating a stiff, noncompliant ventricle typically seen in diastolic dysfunction
C. Opening snap, indicative of mitral stenosis with a thickened mitral valve
D. Ejection click, consistent with a bicuspid aortic valve or pulmonic stenosis
Correct Answer: A
Rationale: The S3 (third heart sound or ventricular gallop) is a low-frequency sound heard early in diastole, immediately after S2. It
is caused by rapid ventricular filling into a noncompliant ventricle and is best heard at the cardiac apex with the patient in the left
